According to the U.S. Department of Labor, women account for 46% of the country's work force. However, women make up only 3.7% of the country's 350,000 paid firefighters.

This slow emergence of females into the fire service has given fire departments ample time to prepare the workplace for their employment. Yet most municipalities have done very little to ready their fire departments for their first female firefighter. One major example of this lack of preparation is the absence of a pregnancy policy.

Developing a pregnancy policy for a fire department should start with an understanding of the hazards that firefighters face and what impact they may have on a pregnant woman and her fetus, the physical limitations a pregnancy places on a woman, the legal guidelines that must be followed during the policy-making process, and the additional details that will make the policy work for the particular organization.

Workday risks

Firefighters are routinely exposed to extreme temperatures during suppression operations. Increased physical exertion while wearing personal protective equipment alone is enough to cause hyperthermia. A body core temperature of 38.9°C (102°F) is considered a teratogenic hazard. Teratogenic hazards are those agents able to disturb or interfere with the growth and development of an embryo or fetus. More often than not, specific teratogenic agents produce specific teratogenic responses. Exposure to teratogens can result in birth defects such as cleft lip, cleft palate, dysmelia, anencephaly, spina bifida, chromosomal abnormalities and ventricular septal defect. Mother's exposure to extreme temperatures has been linked to a number of these birth defects.

Fires also create toxic atmospheres. The by-products of combustion vary depending on what types of materials are fueling the fire. Some of the common ones include carbon monoxide, hydrogen cyanide, acrolein, formaldehyde, benzene, acetaldehyde and formic acid. The most prevalent of these gases is carbon monoxide, an asphyxiant that interferes with the delivery of oxygen to the body by attaching to the hemoglobin in red blood cells faster than the oxygen can. An elevated breathing rate caused by the strenuous activities of firefighting increases this process.

Although the mother may be asymptomatic following a small exposure to carbon monoxide, the developing fetus is at greater risk. And while there are no known links between maternal exposure to carbon monoxide and birth defects, there is an increased risk of behavior problems, low birth weight and fetal mortality.

Hazmat incidents expose all firefighters working the incident to certain risks. Although it is unknown whether chemicals and compounds are mutagens or teratogens, the warning labels on prescription bottles and household solvents indicate the dangers various chemicals can pose.

Pregnant firefighters responding to hazmat incidents at medical facilities may be exposed to unsafe levels of ionizing radiation. Both the Occupational Safety and Health Administration and the U.S. Nuclear Regulatory Commission warn of the risk ionizing radiation may have on a pregnant patient or medical workers. Exposure to levels above normal could increase the chance of miscarriage, malignancies or major congenital malformations in embryos. A fetus is most vulnerable to radiation-induced central nervous system damage eight to 15 weeks after conception. Ionizing radiation also has been linked to childhood cancer.

Many of the same agents used in bioterrorism are present at typical EMS incidents. These agents can enter a body through inhalation, skin contact or ingestion. The National Institute for Occupational Safety and Health lists a number of disease-causing agents that are hazards to pregnant firefighter/EMS workers. Human parvovirus (B19) is linked to miscarriage. Hepatitis B is linked to low birth weight. German measles and chicken pox are linked to low birth weight and birth defects. Cytomegalovirus is linked to low birth weight, birth defects and developmental disorders. And the human immunodeficiency virus is linked to low birth weight and childhood cancer. In addition to the harm these agents or diseases could cause, a combative or belligerent patient could physically injure both the firefighter and fetus.

Technical rescues can be draining, both physically and emotionally. NIOSH lists strenuous physical labor such as prolonged standing and heavy lifting as a reproductive hazard to women. The agency also notes that emotional stress can have a detrimental effect on a woman's overall health. Strenuous activity involved in rescue operations can result in miscarriages late in the pregnancy or premature delivery.

The pregnancy in and of itself may increase the firefighter's risk of injury. The nausea, vomiting and dizziness often common early in the pregnancy and the changes in weight and center of gravity in the second and third trimesters could make a pregnant firefighter a liability to herself and her co-workers at an incident.

The firehouse itself can be an unpleasant environment for a pregnant firefighter. The piercing noise of sirens, air horns and loud speakers mixed with sleepless nights and long shifts can make the surroundings anything but comfortable.

Legal guidance

There are two federal laws and two Supreme Court decisions that set the guidelines for pregnancy polices. They are the Pregnancy Discrimination Act of 1978, the Family Medical Leave Act of 1993, California Federal Saving and Loan v. Guerra, and United Auto Workers v. Johnson Controls.

The PDA states that “women affected by pregnancy, childbirth, or related medical conditions shall be treated the same for all employment-related purposes, including receipt of benefits under fringe benefit programs, as other persons not so affected but similar in their ability or inability to work.” It covers employers with 15 or more employees and applies to employment agencies; labor organizations; and federal, state and local governments. In essence the PDA guaranteed pregnant women the availability to the benefits already in place for other employees.

Although the PDA's intent is equality of treatment to all employees, several states developed policies authorizing specific benefits to women during pregnancy and childbirth. The California state legislature guaranteed up to four months of unpaid leave for childbirth and recovery. The California Federal Savings and Loan Association challenged the law on the grounds that it violated the PDA by providing special benefits not afforded to others. The case made it to the Supreme Court, which upheld the California law and in doing so clarified the intent of the PDA. In the majority opinion Justice Thurgood Marshall stated that the federal law was intended to “construct a floor beneath which pregnancy benefits may not drop, not a ceiling above which they may not rise.”

The California Savings and Loan decision gave employers the ability to offer pregnant workers benefits better than those offered to other workers. This led to the development of “fetal protection policies” by employers who felt it clearly was within their rights. The policies did not take into consideration the ability to do the job; they dealt only with the reproductive health of men and women and the developmental health of a fetus. In the majority opinion in United Auto Workers, Justice Harry Blackmun stated, “Decisions about the welfare of future children must be left to the parents who conceive, bear, support and raise them rather than the employers who hire those parents.”

The PDA and the two subsequent Supreme Court decisions had a major impact on pregnant workers and the policies applicable to their employment. But it was not until Congress enacted the FMLA in 1993 that medical leave was mandated for pregnant workers. The FMLA guarantees 12 weeks per year of unpaid pregnancy leave. The employee must have worked for the employer for a period of one year or 1,250 hours during the previous year. The employee's health coverage must continue during this leave and there should be no loss of any other employment benefits the employee earned or is entitled. The employee must be reinstated to their original position or one with equivalent pay, benefits, terms and conditions. The employer may require the employees to use accumulated sick and vacation leave as part or all of the pregnancy leave.

Department policy

With knowledge of the risks firefighting poses to a pregnancy and an understanding of the law, a departmental pregnancy policy should be developed. The policy should be reasonable and written in the best interests of all parties involved. The policy should outline all procedures to be used and all options available to the pregnant firefighter. All fire departments should have a pregnancy policy in place; departments with no females should implement a policy in anticipation of hiring women.

Education should be a big part of any pregnancy policy. The education needs to include an understanding of the risks involved and the federal laws and court decisions that must be followed. A training program should be put in place that includes the medical and legal information, an understanding of the pregnancy policy, and how it is to be followed. The training should start in recruit school, continue yearly and include all department members. It is just as important to understand how to administer a policy as it is to follow it. Including all department members also would give every member a better understanding of why a pregnancy policy is necessary and help to ease any resentment.

The pregnancy policy should include guidelines for the pregnant firefighter to report her condition to the department. Reporting the pregnancy can't be mandated but should be strongly encouraged. The department can require this information and a physician's statement before extending any leave or altered duties, provided the requirement exists for the granting of other sick or injury-related leaves. A reasonable pregnancy policy will help ensure that a pregnancy is disclosed early.

When a pregnancy is disclosed, the firefighter should be given a medical release form for her physician to use to assess her ability to perform the essential job functions. This medical release form should be developed as part of the pregnancy policy and in accordance with NFPA 1582, Comprehensive Occupational Medical Programs for Fire Departments. This standard will help the physician gain a thorough understanding of the physical demands of the job. It also will help the physician to best gauge when the pregnant firefighter's duties should be modified.

In developing the policy, the department should understand the negative implications of not having a light-duty or non-hazardous assignment provision. A pregnant firefighter is more likely to risk her health and the health of her fetus if faced with the non-paid leave to which she is entitled by the FMLA. Alternative duty could include assignments in fire administration, fire prevention, training or communications. Assignments could even involve public education in the school systems or attending training seminars. Light-duty/non-hazardous assignments can be offered for just pregnancies and not other temporary disabilities; however the reverse is illegal.

Fire departments can require the pregnant firefighter to use sick time or vacation leave to meet the FMLA's entitlement. If economically feasible, some type of paid maternity leave should be instituted. Requiring women to exhaust their accumulated sick time may leave them short when it may be needed later in their careers and the vacation time would be more useful as a new parent. If it is necessary to mandate the use of sick time and vacation leave, consider extending both in situations where the employee has not accumulated a sufficient amount.

The firefighting gear and work uniform should both be addressed in the pregnancy policy. Pregnant firefighters who are able and wish to continue with their fire suppression assignment may need to be re-fitted for turnout gear. Regardless of the assignment, the work uniform will be an issue. Consideration should be given to a modified maternity station uniform. For light-duty/non-hazardous assignments, civilian clothing could be an option. It is important that the pregnant firefighter be comfortable while remaining to feel part of the organization. If reassigned she will know which option works best for her. Spelling this out beforehand, including which parties will be responsible for the purchase, will alleviate a potential future problem.

Should the pregnant firefighter's ability to perform the job functions become an issue, the safety of other firefighters and the public becomes an additional concern. If the fire department must remove the pregnant firefighter from active duty against her will, it can do so as long as it is done in the same manner as any other circumstances. The department's pregnancy policy should outline the procedure to be used should it become necessary.

Pregnancy policy can be part of the fire department's collective bargaining agreement. From a management perspective, this could be committing to more than is necessary. Collective bargaining agreements, however, are a product of negotiations or arbitrations and somewhat guarantee that all parties involved had input.

Regardless of how the pregnancy policy is instituted, it should be approved by the fire department's municipal legal advisors. Care should be taken to make sure the policy is reviewed on a regular basis. Any changes in the current law through legislation or court decisions should be incorporated into the pregnancy policy in a timely manner.

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Joseph D. Rush III is a battalion chief and 21-year veteran of the Atlantic City (N.J.) Fire Department. He has a bachelor's degree from LaSalle University and is working on his master's degree at Saint Joseph's University. In August 2008 he was accepted into the National Fire Academy's Executive Fire Officers Program.

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